Snapshot A 27-year-old woman presents to her gynecologist for evaluation of bumps in her pubic area. She recently tried shaving her pubic hair. A day after she shaved, she noticed red bumps that are pruritic and painful. On physical exam, there are dozens of 1-2 mm hyperpigmented firm papules. She is counseled on available topical therapies to minimize symptoms and advised to use other methods of hair removal, such as waxing. Introduction Clinical definition chronic inflammatory disorder of hair follicle related to shaving, characterized by painful and pruritic papules “razor bumps” “shave bumps” “ingrown hairs” Epidemiology Demographics male > female often affects African Americans Location hair-bearing areas Risk factors shaving tightly curled hair EtIOLOGY Pathogenesis pseudofolliculitis barbae is NOT a true folliculitis inflammatory reaction occurs when hair shaft transects the wall of the hair follicle or when the hair shaft enters the epidermis entrapment of short hairs causes inflammatory response Presentation Symptoms skin lesions are painful and pruritic Physical exam firm and skin-colored or hyperpigmented papules and pustules there may be loops of hair emerging from the follicular orifice located on cheeks, jaw, or neck (in hair-bearing areas) Studies Labs none Biopsy not necessary unless clinical diagnosis is unclear Histology intraepidermal neutrophils abscess formation in dermis granulomatous inflammation with foreign-body giant cells around the penetrating hair Differential Folliculitis Cutaneous sarcoidosis does not have embedded hairs and lesions may be outside of hair-bearing areas Treatment Conservative other methods of hair removal indication to avoid shaving as this causes pseudofolliculitis barbae modalities depilatory hair removal laser hair removal waxing Medical topical therapy indication to reduce symptoms drugs (all topical) retinoids corticosteroids antibiotics eflornithine alpha-hydroxy acids (chemical exfoliants) Complications Scarring or keloid formation Secondary bacterial infection Prognosis Often recurs